内镜超声在消化道黏膜下肿瘤诊断与治疗中的价值

Endoscopic ultrasonography in diagnosis and therapy of gastrointestinal submucosal tumors

目的评价内镜超声在消化道黏膜下肿瘤的诊断及治疗中的价值。方法对内镜检查中怀疑黏膜下肿瘤者进行内镜超声检查,根据黏膜下肿瘤的起源层次及性质决定治疗方案,内镜治疗包括内镜下黏膜切除术、黏膜剥离-肿瘤摘除术、高频电切术及硬化治疗。结果73例良性间质瘤起源于黏膜肌层,7例直肠类癌位于黏膜固有层;脂肪瘤13例、异位胰腺17例、胃底静脉曲张5例、囊肿6例起源于黏膜下层;95例良性间质瘤及21例恶性间质瘤起源于固有肌层,1例类癌侵及固有肌层。61例源于黏膜肌层及8例源于固有肌层的良性间质瘤、8例脂肪瘤、8例异位胰腺及7例类癌经内镜切除,4例囊肿行内镜下穿刺治疗;33例源于固有肌层的良性间质瘤、18例恶性间质瘤、2例脂肪瘤、2例异位胰腺及1例类癌经手术切除。病理符合率为97·97%。结论超声内镜能够对消化道黏膜下肿瘤进行起源和定性诊断,对黏膜下肿瘤治疗方案的选择具有重要的指导意义。

Objective To evaluate the diagnostic value of Endoscopic ultrasonography（EUS） and endoscopic therapies in gastrointestinal submucosal tumors under the guidance of EUS. Methods Patients underwent endoscopy for dyspepsia at our unit. Two hundred and thirty eight patients were found to have a presumed submucosal tumor （SMT） and all subjected to Endoscopic uhrasonography （EUS）. Endoscopic therapy including endoscopic mucosal resecation（ EMR）, endoscopic mucosa strip removal （ EMSR）, snare cauterization,sclerotberapy or surgery operation had been taken according to the different deriving layers of submucosal tumors. The ultimate diagnosis was confirmed by histology. Results Seventy three stromal tumors derived from muscularis mucosa,7 carcinoid in mucosa propiria; 6 cysts, 13 lipomas, 17 etopic pancreases in stomach and 5 varices in gastric fundus derived from submucosa; 95 benign stromal tumors and 21 malignent stromal tumors derived from muscularis propria, 1 carcinoid invaded muscularis propria. 61 benign stromal tumors derived from muscularis mucosa , 8 benign stromal tumors derive from muscularis propria, 8 lipomas, 4 cysts, 8 etopic pancreases and 7 carcinoids were resected by endoscopy; 33 benign stromal tumors from muscularis propria, 18 malignent stromal tumors, 2 lipoma and 2 etopic pancrease, 1 carcinoid were resected surgically. Submucosal tumors 97.97% diagnosed by EUS were identified by pathology. Conclusion Different layers of gastrointestinal tract with submucosal tumors can be distinguished clearly by EUS, leading to definite diagnosis of submucosal tumors. EUS is important in selecting treatment procedures of submucosal gastrointestinal tumors and should routinely be performed on all presumptive submucosal tumors prior to attempt at removal.